Wednesday, March 21, 2007

Flu Shot Rant: Part Deux

For those of you who have been following this blog since last fall, you know how the issue of flu shots just irks me. For part one of this story, read the first flu shot rant. Now, as the flu season is coming to an end, this post is part two.

In this Associated Press story from March 21, it talks about how 10 million flu shots will need to be destroyed because of the expiration date of June 30th.

Wasted vaccine means lost money for drug companies and one stopped making flu shots because of it — setting the stage for a flu shot shortage in 2004.

Wait a minute. Since when does the press care about drug companies making money? There's this UPI story describing a JAMA study talking about drug companies spending millions of dollars on evil doctors. Don't get me wrong, I myself am not a fan of big pharma, just pointing out the hypocrisy.

Getting back to flu shots, I'm having a difficulty understanding why the June 30th expiration date is chosen for annual flu shots. I thought that it was because of the shelf life, but apparently, chemically, these doses are still good. So, it's not a chemical expiration date. It's a business expiration date.

The June 30 date is mostly to ensure that all old vaccine is gone before new doses come out. "There is some benefit to a system where unused vaccine is discarded even if it hasn't really lost that much potency," said Dr. John Treanor, a vaccine expert at the University of Rochester in New York.

Old vaccine could be a tough sell if one of the strains is not well-matched to what's expected to circulate. "You'd have to tell people next year that the vaccine they got could be inferior," said Dr. Walter Orenstein, a vaccine expert at Emory University.

One more argument for the current system: Straying from a set expiration date for an entire season's vaccine would probably cause a huge headache for those trying to manage vaccine supplies, and for manufacturers trying to calculate the following season's demand, added Dr. Carolyn Bridges of the federal Centers for Disease Control and Prevention.

Ok, I'm not an epidemiologist nor an infectious disease specialist, but aren't flu shots manufactured guessing what the flu strains could be? So, if I had some expired flu vaccine on hand that I could give out during the annual initial flu shot shortage, wouldn't a potentially "inferior" vaccine be better than no vaccine at all?

Stockpiling leftover vaccine until new vaccine is available "doesn't sound like an unreasonable thing to be doing," said another vaccine scientist, Dr. Robert Belshe at St. Louis University. After all, usually only one of the three vaccine strains changes — often, only slightly. Twice in the last decade, the recipe didn't change at all, said Alexander Klimov, a CDC flu strain expert.

And three times in the last decade, the vaccine strains recommended for the United States in one winter were identical to what was recommended for the Southern hemisphere the following summer, he said.

Also, several recent studies showed that even poorly matched vaccine can still be highly effective — something to consider amid worries about bird flu and efforts to stockpile vaccine to protect in a pandemic.

Here's just a friendly suggestion for the Food and Drug Administration. Why not do away with the June 30th expiration date for the flu vaccine? We can definitely stop the annual cycle of madness in which people get angry in the fall for not having their flu shot on demand, and the press in the spring bring up the fact that millions of flu shots are wasted.

But, this is the government we're talking about - meaning bureaucracy and the status quo. So, nothing will be done. This means that come this fall, we'll talk about this cycle starting again. And, I'll be here to rant about it.

The first commenter has some very good points. How long is the flu vaccine effective? So did we get the same vaccine three years in a row unnecessarily? Have they done studies on this? We all blindly show up each year to get it. I got it in the hospital where I worked for years then every year since I've retired.More interesting than you thought Dr A.

ha! i remember the first rant well. we had you giving cyber flu shots at the ba meeting when i just got back to florida the end of september. and now the season ends. it is almost time to go back to podunk, a matter of weeks now. stay well doc, later gator...bee

Doc A: I'm not sure you've heard the news but the Flu Strain Selection Group connected to the CDC has said they do not think they will be changing the three strains of flu in the vaccine for the upcoming 2007 season. (They normally make this selection in March or April, so the timing's right.) I'm not exactly sure where I read it, but I do know it was leaked quietly in the past three weeks. And now they want to destroy the 2006 season now. You are so right when you think it's a business decision vs. a pharmacy expiration decision.

Also to a couple of you other commenters: normally you need to get the latest flu vaccine every year as they (the CDC,) change the "mix" of flu viri in it annually. This is based on the CDC's best guess of what flu viri we're going to see coming into the population next winter. So thinking you're covered if you get it 3-4 years in a row you can skip a dose/shot isn't recommended.

FYI: I am a part of group working made up of the CDC and bloggers. I'm one of the bloggers.

I have never gotten a flu shot, even while working at the hospital. I have had the flu 3 times in my life. Ha! I remember with the last bout that even the skin on our back hurt. The whole bird flu threat was unnerving last year. My understanding is that it is still a threat, but for some reason not getting as much press.

To all those people who have never had the flu or have never had it badly, congratulations to you. Personally I got a bad flue in the fall of 89 and have never been the same. I spent four weeks flat out in bed not caring whether I lived or died. The end result, according to my GP is that this is where my fybromyalgia, chronic fatigue and chronic pain originated. Is it true? I don't know, I do know that I now get the shot every year and haven't had the flu since. Maybe it's just luck...ciao